Lopes Diogo, Loureiro Tomás, Machado Inês, Campos Nuno
Department of Ophthalmology, Garcia De Orta Hospital, Almada, Portugal.
Neuroophthalmology. 2020 Jun 22;45(5):317-319. doi: 10.1080/01658107.2020.1755699. eCollection 2021.
The association of internuclear ophthalmoplegia (INO) with exotropia in the contralateral eye is a rare finding, known as non-paralytic pontine exotropia (NPPE). We report a case of an 80-year-old woman with acute onset of diplopia on admission who presented with left eye exotropia with left-beating nystagmus whilst fixating with the right eye and inability to adduct the right eye on left gaze. Brain magnetic resonance imaging showed two small areas of vertebrobasilar territory ischaemic stroke, one beneath the inferior portion of the aqueduct and another in the right occipital lobe. Our case highlights an interesting clinical manifestation of brainstem infarction that, along with ocular motility examination, allowed us to review its pathophysiology, including the influence of the contralateral paramedian pontine reticular formation stimulation in the mechanism of contralateral exotropia in NPPE. The fast clinical resolution of these cases can explain the scarcity of NPPE reports.
核间性眼肌麻痹（INO）与对侧眼外斜视相关是一种罕见发现，称为非麻痹性脑桥外斜视（NPPE）。我们报告一例80岁女性患者，入院时急性起病出现复视，右眼注视时左眼外斜视伴向左跳动性眼球震颤，向左注视时右眼不能内收。脑磁共振成像显示椎基底动脉供血区有两个小面积缺血性卒中灶，一个在导水管下部下方，另一个在右侧枕叶。我们的病例突出了脑干梗死的一种有趣临床表现，结合眼球运动检查，使我们能够回顾其病理生理学，包括对侧脑桥旁正中网状结构刺激在NPPE对侧眼外斜视机制中的作用。这些病例快速的临床缓解可以解释NPPE报告较少的原因。
